ABSTRACT
Introduction: The demand of long term central venous access devices has risen over the last few decades. These devices are increasingly being used for administration of antibiotics and chemotherapeutic drugs, for total parentral nutrition and providing high flow access for hemodialysis and plasmapherisis. Inadvertent arterial puncture, ateriovenous fistula, thoracic duct injury, brachial plexus injury, laceration of the subclavian vein, and air embolism are the well described complications of the central line insertion
Objective: This study was designed to find out the frequency of complications during Central venous line insertion via sub clavian route
Methodology: This cross-sectional descriptive study was conducted at DHQ Hospital Sargodha from April 2014 to April 2015. Two hundred patients both male and female requiring hemodialysis were included in the study. All patient underwent double lumen catheterization of subclavian vein after informed consent
Results: Mean Age of the patients was 54.55 +/- 10.45. 71% of the patients were female and 29% of the patients were male. Out of 200 patients subjected to double lumen catheterizations; 28 [14.0%] developed various complications related to insertion. Out of 28 patients who developed complications, in 08 [28.57%] cases complication was failure to cannulate, in 08 [28.57%] cases there was arterial puncture, in 04 [14.28%] cases catheters were mal-positioned/kincking. Hemothorax and subclavian arterio-venous fistula developed in 02 [7.14%] each. 02 [7.14%] cases had arrhythmias and death occurred in 02 [7.14%] cases
Conclusions and Recommendations: Subclavian double lumen catheters proved to be reasonably safe, easy and a reliable way of obtaining vascular access for hemodialysis. The procedure is a short term alternative to AV fistula formation for patients requiring long term hemodialysis. It is recommended that double lumen subclavian vein catheterization should be part of post graduate training in large units where hemodialysis is available
ABSTRACT
Chronic Cholecystitis is one of the commonest diseases presenting in surgical department and is subjected to cholecystectomy each time. Asuspicious gall bladder on ultrasound initiates further investigations to rule out carcinoma of gall bladder yet some times a benign looking gall bladder on ultrasound turns out to be carcinoma of gall bladder on histopathology. Descriptive study. District Head Quarters Hospital, Sargodha, from September 2007 to March 2009. 200 patients who underwent both open and Laparoscopic cholecystectomy for cholelithiasis were subjected to this study. All relevant data was documented on a standardized data form. Patients were between the ages of 28-74. Patients already diagnosed as Gallbladder Carcinoma, empyema gall bladder, mucocele and gall bladder polyp were excluded from the study. Gall bladders removed after each surgery ware sent to laboratory for histopathological evaluation. A total of 200 cases were studied [161 females, 39 males; M: F ratio 1:4]. The mean age was 45 years [range 28-74 years]. The most common presenting complaint was pain right hypochondrium with nausea and vomiting [85%].The average operating time was 50 minutes in case of open cholecystectomy and 1 hour in laparoscopic cholecystectomy. Complications included biliary leak in 2 patients [1%], Wound Infection in 3 patients [1.5%] and death in one case [0.5%]. The overall rate of complications was 3%. There were a total of 5 patients of laparoscopic cholecystectomy who required extension of the incision, for Carcinoma Gallbladder. Carcinoma of gall bladder is a very aggressive malignancy and usually presents at a very advance stage as its symptoms mostly are marked by symptoms of cholecystitis. Detection of gall bladder carcinoma is very difficult in early stages on ultrasound. Any findings in ultrasound suggesting malignancy should be confirmed on further investigations like CT scan .Carcinoma of Gall bladder is not very common in cases of cholecystectomy for chronic Cholecystitis but once found should be dealt with extreme precision following established operating protocols